Treat Blepharitis- How To Do Eye Lid Cleaning

Baby shampoo has long been recommended as a means to clean the eyelids due to its gentle surfactant properties and affordability. Many clinicians doubt its efficacy, and patients almost always neglect our “as directed” recommendations, which beg the question of what is considered efficacious (and realistic). If we only want to recommend general wellness to the non-disease-bearing patient, then it may be enough—it has to be better than nothing! For the patient with lid disease though, baby shampoo fails to sufficiently reduce the microbial load, and more aggressive hygiene is needed.

There are a number of products available as a foam or pre-moistened wipe. Despite the significant overlap in their formulations, they all have a few key ingredients that differentiate themselves from the others and from baby shampoo. In the presence of blepharitis, frothy tears, small marginal infiltrates, etc., consider one of the following in your treatment plan:

  • SteriLid contains linalool, which is thought to condition the skin and maintain oils that have antimicrobial properties. Tea tree oil and sodium perborate, a preservative, both may, further reduce the bacterial load.
  • OCuSOFT Lid Scrub products are marketed as Original for mild to moderate disease or Plus for moderate to severe disease. These products contain 1,2-hexanediol and 1,2-octanediol, which can penetrate bacterial cell membranes, induce cellular leakage, and thus provide antibacterial properties.
  • Systane Lid Wipes contain benzyl alcohol, which is traditionally used as a preservative, though it may function to reduce bacterial counts when applied to the lid.

Since surfactant cleansers are capable of drying the skin, oil-based cleansers may be a reasonable alternative for some patients. Mineral oil is well tolerated and an excellent skin moisturizer that is capable of removing make-up and lash debris. (Personal testimonial: I have been using a mineral oil-based emollient to remove eye make-up for 15 years!) The antimicrobial effects of coconut oil have been well documented, and its extracts are found in each of the lid scrubs discussed above. Dilute tea tree oil shampoo can also be used, but take caution as it may cause irritation and is not recommended for children or pregnant women. So, help your blepharitis patients in reducing bacterial overgrowth of the eyelids; abandon the baby shampoo and recommend one of these more effective products.

To control Blepharitis and Get Dry Eye Relief- Use TheraLife Eye.

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Dry Eye Management in Clinical Practices

eye check up 121optometrists.co.uk

 

We hear very often that eye doctors prescribe eye drops, and the drops don’t work.  Let’s see  what eye doctors see in their clinical offices.

In this new research, invitations to complete a 17-question online survey were mailed to 400 members of the North Carolina Ophthalmology and Optometry Associations including community optometrists, comprehensive ophthalmologists, and cornea specialists.

Results indicate the following :
1. Symptoms

Burning >> foreign body sensation> tearing

2. Eighty percent (80%) of the eye doctors indicate eye drops is the most recommended treatment.

3. High failure rate for eye drops, including cyclosporine A

4. Concurrent medication indiations that occur with chronic dry eyes are- Rheumatoid arthritis, Sjögren syndrome, anxiety and depression, history of LASIK surgery, smoking, and thyroid disease.

5. Heavily relying on subjective symptoms rather than testing for dry eyes such as Schirmer’s Test, Tear Breakup Test, Tear Osmolarity Test etc.  Rarely examine the condition of meibomian (oil) glands.

CONCLUSIONS: The survey provided an informative snapshot into the preferences of eye care providers concerning the diagnosis and management of dry eye disease.

Overall, burning was the most common symptom reported by patients.

Providers relied more on patient history in guiding their clinical decisions than objective signs.

The survey underscores the incongruence when comparing subjective symptoms with objective signs, thereby highlighting the urgent need for the development of reliable metrics to better quantify dry eye symptoms and also the development of a more sensitive and specific test that can be used as the gold standard to diagnose dry eye.

To read more

Perceptions of Dry Eye Disease Management in Current Clinical Practice
Williamson JF, Huynh K, Weaver MA, Davis RM. Eye Contact Lens. 2014 Mar;40(2):111-5.

healthyeyeTheralife Eye has been shown to be 80% effective in a Phase II clinical trial.

Theralife Eye is unique in its ability to stop tear over production for people with watery dry eyes.  It restores your own tear secretion functions naturally resulting in balanced, sustainable tear secretion all day long.
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Contact lenses causing cornea ulcers.

contact-lens[1]An increase in the use of contact lenses may be making ulcers of the cornea twice as common.  A study of over a million Californians showed that people who wore contact lenses were 9 times more likely to suffer from corneal ulcers.  Many people do not follow basic contact lens safety principles.

Researcher Dr. David Gritz of Montefiore Medical Center in New York told Reuters Health: “As new contact lens innovations become available, and people hear that they can wear these contact lenses for weeks or a month without taking them off, they do just that. They don’t realize the dramatic increase in risk it causes them. Our eyes do need breaks from contact lens wear.”  He went on to say, “Contact lenses can even act as a bandage over eye irritation, covering up symptoms.”

TheraLife Can Help

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People infected with HIV were also nine times more likely to develop the condition than those who were HIV negative.
Contact lenses also provide a surface for tears to evaporate, causing chronic dry eyes.  Wash and clean your contact lenses often, do not sleep with them in and get TheraLife Eye capsules to relief dry eyes naturally.

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Why eye drops make your eyes drier!

You have dry eyes.  Your eye doctor told you to use eye drops.   Your put the eye drop into your eyes. Your eyes are dry again in 10 minutes.  Does this sound familiar?

Your eye doctor may suggest that you use preservative free eye drops, get eye drops.  Nothing seems to be helping.  Why?

Eye drops make your eyes drier over time. 

Eye drops provide temporary relief.  Over time, they wash away the natural lubricants your eyes produce- just like washing your eye balls under a faucet.  The increased dryness makes inflammation worse, and your dry eyes unbearable.

Of all the eye drops, decongestant eye drops such as Visine, are the worst. Visine constricts blood vessels in your eye to take the red out. Long-term use can cause your eyes to become dependent on these eye drops, and when you stop, the blood vessels become even larger, making red eyes worse.

After all this, your eyes are still dry, irritated, red, sometimes painful, and your vision is blurred. It is even possible to develop corneal ulcers from prolonged chronic dry eye conditions.

So why don’t drops work for my chronic dry eye?

The answers resides in our tear composition and tear secretion glands:

  1. Lacrimal Glands- This gland produces the bulk of your tear and creates tear volume
  2. Meibomian Glands- This gland secretes thickening agents (proteins, lipids, and mucin) to prevent tear evaporation and protects the eye

Our body requires that the tear volume and tear thickness be balanced and secreted evenly over time in order to provide eye comfort. Most of the treatments listed above address either one or the other requirements, but not both:

  •  Eye drops – compensate for the lack of tear volume
  • - Oily eye capsules – compensate for the lack of tear viscosity (thickness), prevent tear evaporation

Over time, the more one uses eye drops, the drier the eyes get. The reason is eye drops wash away the lubricating thickening agents that your Meibomian Glands produce and eventually train your eyes not to secrete tears. It becomes a conditioning reflex.

Overuse of eye drops usually is more than 4-5 times/day.  This includes antibiotic eye drops, dry eye medications, or glaucoma drops.

For chronic dry eyes, you need balanced, sustainable tear secretion throughout the day. TheraLife Eye Enhanced can help!

TheraLife® Eye Enhanced works by increasing intracellular metabolism (Mito-Activation), which enables us to stimulate the all the tear glands (meibomian and lacrimal glands) to secret its own balanced tears naturally and overcome the key issue in chronic dry eye syndrome.

How does TheraLife Eye work?  What is in TheraLife Eye? click here.
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Dry Eyes and Watery Eyes

One of the most common questions asked is “ I have tears running down my cheek, how can I have dry eyes?

The answer is counter intuitive.  One of the most common cause of watering eyes is dry eyes.

Watering eye, also known as epiphora or tearing eye, is a condition in which there is an overflow of tears onto the face, often without a clear explanation

Epiphora can develop at any age. It is more common among babies aged under 12 months, and adults over the age of 60 years. The condition may present symptoms in just one or both eyes.

Depending on the severity of symptoms, watering eye can sometimes make driving difficult and dangerous

Common Causes of Epiphora- Tearing Eyes

1. Dry Eye Syndrome- more than 50%
2. Allergies-  test for allergies for try allergy medications
3. Blocked tear ducts- tear cannot drain
4. Blepharitis or conjunctivitis – eye infections
5. Trichiasis – inward-growing eyelashes
6.Ectropion – this is when the lower eyelid turns outwards

Why Dry Eyes Cause Tear Over Production?

It may not make sense, but dry eyes often lead to watery eyes. When eyes dry out, they become irritated and uncomfortable. That prompts the brain to signal the eyes to cry.  This type of tear is called Reflex Tear which is of poor quality.  The lacrimal glands is now producing so many tears that it overwhelms the eye’s natural drainage system.

Tear production tends to lessen with age, therefore, dry eyes are more common in older adults.

In addition to excessive tearing, symptoms of dry eye syndrome may include blurred vision, itchy eyes, or burning eyes.  All these symptoms are consistent with dry eye syndrome.

Some medical conditions and medications can lead to dryness as can a dry and windy environment, but the most common cause of dry eye syndrome is a chronic condition called keratoconjunctivitis sicca (KCS). People with this condition make tears, but the tears do not contain enough water or thickness.

How to stop tear over production

Artificial tears make watery eye condition even worse.

The proper way to relief watery dry eyes is to:

  1. Balance tear production – restore normal cell functions to tear secretion glands – lacrimal and meibomian glands
  2. Train your brain to stop crying – to stop tear over production.

TheraLife Eye can help!

TheraLife Eye restores both lacrimal and meibomian gland functions in order to establish balanced, sustainable tear for lasting relief.  Learn more

 

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Digital Media Impact on Vision Health

Report Examines the Impact of Digital Media on Vision Health 

A report recently released by The Vision Council finds that nearly 70% of U.S. adults experience digital eye strain while on digital devices – including computers, tablets and smartphones. Yet, about half of adults don’t know how to or have never tried to reduce their visual discomfort. As the market experiences a surge in high technology-related digital device purchases, computer glasses and other “eyegonomic” techniques are encouraged to minimize strain.

The Vision Council describes digital eye strain as the physical discomfort experienced after two or more hours in front of a digital screen. Symptoms typically include dry, red or irritated eyes; blurred vision; fatigued eyes; back, neck or shoulder pain; and/or headaches. While not permanent, digital eye strain can be painful and irritating and often affects work productivity.

In addition to tiring the eye’s focusing system, many digital devices emit high-energy visible (HEV) or blue light, which may have long-term effects on vision health. Research suggests that overexposure to HEV light can damage the retina and increase the likelihood and severity of eye disorders such as age-related macular degeneration and cataracts. However, The Vision Council finds that six in 10 adults are unaware of the harmful consequences of HEV light.

To view or download a copy of DigitEYEzed: The Daily Impact of Digital Screens on the Eye Health of Americans, visit The Vision Council online at www.thevisioncouncil.org.

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Vision strain and fatigue often lead to chronic dry eyes.  TheraLife Eye is clinically proven to restore tear secretion naturally with lasting results.  Get relief today!

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Eyes Tell Secrets of Stroke and High Blood Pressure.

 

Retina Photograph of high blood pressure people may help detect stroke risk according to new research published in American Heart Association journal “Hypertension”.

High blood pressure is the world’s single most important risk factor for stroke, yet, it is nearly impossible to predict which hypertension people are going to develop a stroke. This research study indicates photographing the retina (retinal imaging) may help detect people who are more likely to have a stroke.

The retina provides information on the status of blood vessels in the brain.  Retinal imaging is a easy, non-invasive, inexpensive way to examine the blood vessels of the retina.

Researchers tracked stroke occurrence for 13 years in nearly 3000 people with high blood pressure who had not previously experienced a stroke. At baseline, each person had photographs taken of the retina, the light-sensitive layer of cells at the back of the eyeball. Damage to the retinal blood vessels attributed to hypertension — called “hypertensive retinopathy” — evident on the photographs was scored as none, mild or moderate/severe. During the follow-up, 146 participants experienced a stroke caused by a blood clot and 15 by bleeding in the brain.

The research study found the risk of stroke was 35 % higher in people with mild hypertensive retinopathy and 137 % higher in people with moderate or severe hypertensive retinopathy. Even in patients on medication and achieving decent blood pressure control, the risk of a blood clot was 96 % higher in those with mild hypertensive retinopathy and 198 % higher in those with moderate or severe hypertensive retinopathy. Researchers adjusted for several stroke risk factors such as age, sex, race, cholesterol levels, blood sugar, body mass index, smoking and blood pressure readings.

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Improve your Retina Blood Vessels with MaculaEye.

Theralife MaculaEye is designed to improve microcirculation, membrane permeability, and blood vessel agility in the eye.  In a research study, the fragile blood vessels in people with diabetic retinopathy was greatly improved over a period of 3 months.  Clinical research data was verified with Dr. August Reader at the California Pacific Medical Center.

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Dry Eye Assessment – Using the Ocular Surface Disease Index (OSDI)

Do you know how severe your dry eye condition is, and if you are getting the proper treatment?

Most eye doctor diagnose dry eyes by using clinical exam, patient’s binary response of yes or no to self-reported symptoms of dryness or burning.  Failure to fully explore the extent of symptoms can result in a delayed diagnosis or even subpar therapeutic management.

Ths Ocular Surface Disease Index1 (OSDI, Allergan) is a questionnaire that has been validated in clinical trials as an accurate and effective adjunct to differentiate normal and transient ocular discomfort from pathologic dry eye. It consists of 12 questions that query the frequency of symptoms, task-related limitations due to ocular discomfort, and environmental stimuli. For each item, the range of patient responses spans from “none of the time” to “all of the time,” corresponding to a numerical 0-to-4 scale. The values are then summed, and the calculated OSDI score2 ranges from 0 to 100 with cut-off values for mild (13-22), moderate (23-32), and severe (33-100) dry eye.3

The OSDI questionaire can be utilized as a screening tool to identify patients who would benefit from a self-referral for a full dry-eye work-up to be performed at a later date. All existing people with dry eyes should also complete the OSDI at each follow-up to monitor for progression and track for response to therapy.

Print out a copy for yourself and track your own symptoms while you take TheraLife Eye for improvement.  Bring a copy to your next visit to your eye doctors.

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1. Tell us your symptoms and dry eye history, what you have been doing so far for dry eye relief- we will give you:

  • Realistic expectations on how long it will take you to recover.
  • What other regimen you should be using in addition to taking TheraLife Eye. e.g. Hot Compresses, eye lid cleaning, antibiotics, steroid eye drops etc.

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Stress and Dry Eye Disease-

We have long suspected that stress at work can create chronic dry eyes. 
Finally a body of scientific evidence that links stress and chronic dry eye syndrome.

Here is an abstract from an article published in Cornea: October 2009 – Volume 28 – Issue 11 – pp S70-S74

There is a growing body of evidence to suggest that oxidative stress may be involved in at least the propagation of cellular injury that leads to eye pathology in various conditions including conjunctivochalasis, dry eye disease, age-related macular degeneration, and UV light-induced and tobacco smoke-induced ocular surface epithelial damage. Oxidative stress is biologically relevant in animals and intimately linked with an integrated series of cellular events. Interaction between these various components is not necessarily a cascade but might be a cycle of events, of which oxidative stress is a major component. Inhibition of oxidative stress therapeutically might act to break the cycle of cell death. The creation of numerous cell and animal models that selectively target the effects of oxidative stress and inflammation to the specifically affected eye region in these diseases has greatly advanced our understanding of the involvement of oxidative stress in eye disease.

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Pros and Cons of Punctal Plugs for Dry Eye Relief.

In people who do not get dry eye relief despite maximal lubrication, punctal plugs are often used.1 Rather than applying an artificial tear, punctual occlusion helps to preserve any remaining natural tear fluid, which has by far the best wetting and nutrient capacity for the ocular surface. Preserving the patient’s own natural tears by blocking the lacrimal drainage system, thereby increasing tear volume and decreasing tear osmolarity, can successfully maintain the integrity of the ocular surface, corneal transparency and visual acuity. In patients with moderate or severe dry eye, it is capable of improving quality of life and preventing vision loss.

Punctal Occlusion for Dry Eye Syndrome

The idea behind punctal occlusion is straightforward: increase the aqueous component of the tear film by blocking tear outflow..Punctal occlusion helps to retain the patient’s own tears on the ocular surface. This intervention is highly effective and usually used after environmental control, drop therapy, omega-3 fatty acid supplementation and topical prescription eye drop prove inadequate. Preferably performed after surface inflammation is brought under control, occlusion methods include punctal plugs as well as thermocautery, electrocautery, laser ablation or direct surgical closure.1

Before performing a procedure to occlude a punctum permanently, many authors suggest a trial of temporary punctal occlusion using various plugs.4 While this is prudent, one must keep in mind some of the intrinsic limitations of these devices. More specifically, failure of collagen plugs to predict epiphora after permanent punctal occlusion. One systematic review7 showed a relative scarcity of controlled clinical trials assessing the efficacy of punctal occlusion therapy in dry eye. Although the evidence is very limited, the data suggest that silicone plugs can provide symptomatic relief in severe dry eye. Moreover, temporary collagen plugs appear similarly effective to silicone plugs on a short-term basis.

The reported results of punctal plugs vary. It seems to work for patients with dry eye of mostly mild to moderate severity. The magnitude of the treatment effect was more striking following implantation of non-dissolvable silicone plugs, but occlusion with temporary collagen plugs also had an apparent beneficial influence on the clinical course of dry eye, as indicated by significantly lower scores for several study parameters in comparison with the control group.

Punctal Occlusion and Inflammation

One area of interest is the relationship of pharmacologic therapies with punctal occlusion.10 Punctal occlusion has been shown to improve objective and subjective measures of dry eye12 but may exacerbate ocular surface inflammation in subjects with overt clinical inflammation.13 Because of this issue, an international panel of experts developing comprehensive treatment guidelines for ocular surface disorders recommended that the inflammatory condition be treated before punctal occlusion.14

Punctal Plugs and Increased Ocular Bacterial Infections

Because puntal plugs back up tears – which does not allow debri and bacteria from draining. Some patients will experience ocular bacterial infections, which require anti-biotic eye drops for treatment.

Complications
Although punctal occlusion is an effective therapy for chronic dry eyes, there are complications related to punctal plug insertions. Recognized complications of conventional silicone plugs include

  • epiphora – over flow of tears onto the face
  • punctal ring rupture,
  • abrasion of the corneal and conjunctival surface,
  • suppurative canaliculitis – infection of lacrimal gland causing surface abnormalities that sometime require surgical interventions.

The retention rates for the different kind of silicone plugs have been reported to be about 50% after one year,extrusion of silicone plugs is common, occurring within three months in up to 50% of cases.

Conclusion
Select the right candidate is critical for successful punctal occlusion. It should be performed only when appropriate, and when the likelihood of benefit far outweighs the risk and cost. A variety of techniques are available to choose from on the basis of the duration of desired effect and the severity of aqueous tear deficiency and associated ocular surface disease. Punctal occlusion can dramatically improve the quality of life in many people with moderate cases of dry eyes and can prevent visual loss in patients with severe cases of dry eyes

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How TheraLife Eye can help!

TheraLife Eye is clinically proven to be 80% effective in dry eye relief for first time users.  TheraLife Eye is effective when puntal plugs, prescription eye drop, eye drops failed. The reason is because TheraLife Eye work on restoring normal cell functions to tear secretion glands,  intracellularly.

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REFERENCES

1. American Academy of Ophthalmology. Punctal occlusion for the dry eye. Ophthalmology 1997; 104: 1521.
2. Freeman JM. The punctum plug: Evaluation of the new treatment for the dry eye. Trans Am Acad Ophthalmol Otolaryngol 1975; 79: 874–87.
3. Dohlman CH. Punctal occlusion in keratoconjunctivitis sicca. Trans Am Acad Ophthalmol Otolaryngol 1978; 85: 1277-1281.
4. Cohen EJ. Punctal occlusion. Arch Ophthalmol 1999; 117: 389–90.
5. Glatt HJ. Failure of collagen plugs to predict epiphora after permanent punctal occlusion. Ophthalmic Surg 1992; 23: 292–3.
6. Redmond JW. Correspondence: Punctal occlusion with collagen implants. Ophthalmic Surg 1992; 23: 642.
7. Ervin AM, Wojciechowski R, Schein O. Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev 2010 Sep 8;(9):CD006775.
8. Geldis JR, Nichols JJ. The impact of punctal occlusion on soft contact lens wearing comfort and the tear film. Eye Contact Lens 2008 Sep; 34(5): 261-5.
9. Nava-Castaneda A, Tovilla JL, Rodriguez L, et al. Effects of lacrimal occlusion with collagen and silicone plugs in patients with conjunctivitis associated dry eye. Cornea2003; 22: 10-14.
10. Yazdani C, McLaughlin T, Smeeding JE, et al. Prevalence of treated dry eye disease in a managed care population. Clin Ther 2001;23:1672–1682.
11. American Academy of Ophthalmology Preferred Practice Patterns. Dry Eye Syndrome. 2003. Available at: http://www.aao.org/aao/education/library/ppp/upload/Dry-Eye-Syndrome.pdf.
12. Dursun D, Ertan A, Bilezikci B, et al. Ocular surface changes in keratoconjunctivitis sicca with silicone punctum plug occlusion. Curr Eye Res 2003; 26: 263–269.
13. Pflugfelder SC. Anti-inflammatory therapy for dry eye. Am J Ophthalmol 2004; 137: 337–342.
14. Behrens A, Doyle JJ, Stern L, et al. The Dysfunctional Tear Syndrome Study Group. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea 2006; 25: 900–907.
15. Yang H, Fujishima H, Toda I, et al. Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis. Am J Ophthalmol 1997; 124:80–7.
16. Sugita J, Yokoi N, Fullwood NJ, et al. The detection of bacterial biofilms in punctal plug holes. Cornea 2001; 20: 362–365.
17. Murube J, Murube E. Treatment of dry eye by blocking the lacrimal canaliculi. Surv Ophthalmol 1996; 40: 463-480.
18. Kojima K, Yokoi N, Nakamura Y, et al. Outcome of punctal plug occlusion therapy for severe dry eye syndrome. Nippon Ganka Gakkai Zasshi 2002; 106: 360–364.
19. Balaram M, Schaumberg DA, Dana MR. Efficacy and tolerability outcomes after punctal occlusion with silicone plugs in dry eye syndrome. Am J Ophthalmol 2001; 131: 30-36.

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